The Washington Post

Health-care reform is a middle-class program

I was sort of surprised at this, from an attack on Barack Obama and the Democrats from the left:

The president, quixotically, sought to save both the poor (with Obamacare, mainly) and the filthy rich (Wall Street) — but at the expense of the bigger victim, the middle class. And they will be the ones to vote him out.

That’s written by Michael Hirsh, who is upset mainly about Dodd-Frank, but I couldn’t let the Affordable Care Act comment pass.

Is that really what liberals concerned with “99%” issues believe? If so, they're dead wrong. It’s just contrary to the facts to portray the ACA as a program for the poor. After all, the poor already had (adequate or not) health care assistance from the government: Medicaid.

For those just above the old Medicaid line, ACA now offers Medicaid. I’m not sure if helping people just over the poverty line counts as helping “the poor”; maybe so.

But the real benefits are for the group just above that. First of all, families making up to 400% of the poverty line – that’s middle class! – will get subsidies to help them afford insurance.

More importantly, establishing a working market for insurance beyond employer-offered plans is a huge benefit for the middle class, many of whom haven’t had good options previously. That’s especially true of those with preexisting conditions, but generally buying insurance on your own has been a disaster; assuming ACA works as intended, that should become ancient history.

Such a market is especially important for any employee at a large company (who therefore probably has excellent coverage right now) who is thinking of starting her own firm. That’s a middle-class problem, and that’s really, more than anything else, what reform targets.

Of course, there's a lot more to the Affordable Care Act, but most of the experiments in better delivery and cost controls will help everyone, from the very rich all the way down, if they pay off. Or, I suppose, they'll hurt everyone if they don't; if conservative skeptics are right and costs soar, then the nation as a whole will be hit. But the core programs? Those are intended to help those who want to buy health insurance right now and either can't quite get access or can't quite afford it, as well as those who are paying for it but are getting a terrible deal. That's not the poor.

For liberals who believe that the combination of exchanges, subsidies and turning private insurance companies into something like heavily regulated utilities won’t work, or won’t work as well as a single-payer system . . . well, that’s an argument worth having. For conservatives who believe it violates liberty — well, that’s a philosophical argument that people will disagree about.

But whatever you think of the legislation, it’s pretty obvious that Barack Obama’s health-care reform is squarely focused on the middle class, not the poor. 


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